Breast reconstruction is often a multi-step, multi-surgery process.
Implants:
1. Most implants today are saline-filled implants, or small silicone shells filled with clean salt water.
2. Silicone implants used to be popular, but now are less popular because of public concern with whether or not the implants cause immune system disease.
Note: for the first two options, there is a risk of the implants bursting or leaking, or cause infections, scarring, breast hardening, and pain. Most implants need replacement within the first 10 years of use. MRI's may be necessary to check if the silicone implants have bursted - these MRI's may not be covered by health insurance.
3. Some breast reconstruction uses fat and muscle tissue from around the body, whether from the tummy, back, buttocks, or thigh, to fill the breast. These procedures are known as "tissue-flap" procedures. With these, there is no worry of implants breaking or having to replace them, but there are two sets of scars where the tissue was taken and inserted.
Immediate reconstruction: After the mastectomy is performed, the plastic surgeon will insert the implant in the space where the breast tissue was, and often will add extra supporting structure to keep the implant in place, like a hammock or sling.
Delayed reconstruction: When the patient is ready for breast reconstruction (after radiation therapy), the first step is to expand the skin over the breast area. A small balloon is inserted under the skin, and over a period of 4-6 months, the balloon is gradually inflated with salt water solution until the breast is stretched enough to fit an implant. Then a second surgery is performed to put in the final implant. Sometimes the balloon is left inside the patient as the implant.